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. 2020 Feb 3;20(1):77.
doi: 10.1186/s12913-020-4902-7.

Emergency department and inpatient utilization among U.S. older adults with multiple chronic conditions: a post-reform update

SangNam Ahn  1   2 , Mustafa Hussein  3   4 , Asos Mahmood  5 , Matthew Lee Smith  6   7
Affiliations

Emergency department and inpatient utilization among U.S. older adults with multiple chronic conditions: a post-reform update

SangNam Ahn et al. BMC Health Serv Res. .

Abstract

Background: The Affordable Care Act (ACA) was enacted to enhance access to care primarily among nonelderly and low-income populations; however, several provisions addressed key determinants of emergency department (ED) and inpatient visits among Medicare beneficiaries over age 65 years. We take stock of the overall changes in these visits among older Medicare beneficiaries, focusing on those with multiple chronic conditions (MCCs), and provide a nationally representative post-reform update.

Methods: We analyzed a sample of 32,919 older adults (65+) on Medicare from the 2006-2015 Medical Expenditure Panel Survey (MEPS). Using a survey-weighted two-part model, we examined changes in ED visits, inpatient visits, and length of stay (LOS) by MCC status, before (2006-2010), during (2011-2013), and after the ACA (2014-2015).

Results: Prior to the ACA, 18.1% of Medicare older adults had ≥1 ED visit, whereas 17.1% had ≥1 inpatient visits, with an average of 5.1 nights/visit. Following ACA reforms, among those with 2+ chronic conditions, the rate of ever having an ED visit increased by 4.3 percentage points [95% confidence intervals [CI]: 2.5, 6.1, p < 0.01], whereas the rate of inpatient visits decreased by 1.4 percentage points [95%CI: - 2.9, 0.2, p < 0.1], after multivariable adjustment.

Conclusions: We found sizable increases in ED visits and nontrivial decreases in inpatient visits among older Medicare beneficiaries with MCCs, underscoring the continuing need for improving access to and quality of care among older adults with MCCs to decrease reliance on the ED and reduce preventable hospitalizations.

Keywords: Affordable care act; Emergency department (ED) visits; Inpatient visits; Length of stay (LOS); Medicare; Multiple chronic conditions; Older adults.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Observed Trends in Emergency Department and Inpatient Visit Probabilities by Multiple Chronic Condition Levels
Fig. 2
Fig. 2
Adjusted Changes in ED and Inpatient Visit Probabilitiesy by Multiple Chronic Condition Levels
Fig. 3
Fig. 3
Adjusted Changes in Total Annual Inpatient Nights (Total Length of Stay) and Average Number of Nights per Inpatient Visit (Average Length of Stay) by Multiple Chronic Condition Levels
See this image and copyright information in PMC

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